Hospital groups unveil plan to deal with surprise bills

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QUICK FIX

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— Hospital groups say they have a plan to deal with patients' surprise bills, a message they stressed to concerned congressional leaders on Wednesday.

— U.S. proposals to import drugs could leave Canada's shelves dry, Canadian economists are warning as enthusiasm builds for the idea.

— Average spending on a Medicare enrollee could near $20,000 by 2027, according to new projections from CMS actuaries.

** A message from the Campaign for Sustainable Rx Pricing: Big Pharma’s out-of-control price gouging has REAL consequences – one in four American patients can’t afford the prescription medications they need to survive. It’s time to hold Big Pharma accountable to these patients – and implement bipartisan, market-based reforms that lower drug prices by fostering competition, transparency and innovation. Learn more: csrxp.org/dose-of-reality**

THIS IS THURSDAY PULSE — Although your author will be honest: After a Monday holiday and Wednesday snow-day, his body clock has no idea what day it actually is.

Driving the Day

HOW HOSPITAL GROUPS SEE SURPRISE BILLS — Six major associations on Wednesday laid out an eight-point vision for shielding patients from unexpected, and often costly, medical bills.

The shared plan — sent to congressional leaders — comes as the issue heats up on the Hill, POLITICO's Rachel Roubein writes. More than 100 medical groups sent their policy solutions to the Hill earlier this month, and several insurer, employer and business groups are collaborating on their own wish list.

— The hospitals’ principles include popular proposals like ensuring the patient isn’t slapped with an exorbitant bill. Hospitals also want patients to have adequate provider networks and let plans and providers retain the right to private negotiations. They say the government shouldn’t create a fixed payment amount or reimbursement methodology for out-of-network care.

“To us, it’s a patient problem that we need to solve,” Chip Kahn, president and CEO of Federation of American Hospitals, told POLITICO. “These people have coverage, and there are ways to make their coverage work for them without them having these problems.”

WOULD U.S. DRUG IMPORTATION LEAVE CANADA's SHELVES DRY? — That's what Canadian economists are warning, saying that it would create shortages in their country while doing little to lower U.S. drug prices, POLITICO's Sarah Owermohle and Alexander Panetta report.

One major problem: U.S. demand could quickly tap out Canada's much smaller market. There are other reasons to be skeptical of the idea, too.

"Why bother to import medicines from the country with the second-highest prices in the world? That is Canada. We’re second only to the United States in drug prices,” said Steve Morgan, a Canadian health economist who has advised the government on pricing reform

But the idea is gaining momentum, as evidenced by five bills in Congress — including one promoted by presidential contender Sen. Bernie Sanders (I-Vt.) — while states like Vermont are barreling ahead with their own plans. Sanders has argued that Canada's fears are unfounded, with a spokesperson suggesting that the pharma industry is trying to "scare" Canadian officials into opposing the pan.

Meanwhile: Florida's GOP governor wants to import drugs from Canada. Gov. Ron DeSantis on Wednesday described his plan to import FDA-approved prescription drugs from Canada as a way to reduce costs to consumers. More for Pros.

AVERAGE SPENDING ON MEDICARE PATIENTS: NEARLY $20,000 BY 2027 — That's one nugget inside the latest spending projections from CMS, which were released Wednesday. Actuaries forecast that national health care spending is likely to increase 5.5 percent annually over the next decade, a slight uptick from recent years but significantly lower than the rapid growth rates that shaped health care for decades.

— One way to read this data: It's a reminder that health spending is still outpacing broader economic growth. Health care spending is expected to account for 19.4 percent of GDP in 2027, up from 17.9 percent in 2017.

And even relatively "slow" health care growth can quickly add up. For instance, actuaries project that spending on the average Medicare enrollee will be $19,546 in 2027, up from $12,347 in 2017. Meanwhile, spending on the average Medicaid enrollee is projected to be $12,029 in 2027, up from $8,013 in 2017.

— The actuaries base their models on current law, which means they don't assume significant coverage expansion,despite Democrats' momentum behind recent proposals like Medicare-for-more. According to the CMS actuaries' model, about 10 percent of Americans will be uninsured in a decade — roughly equivalent to the share today.

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AROUND THE NATION

Connecticut pushes taxes on vaping, alcohol and soda. It's part of a budget plan unveiled by Gov. Ned Lamont on Wednesday, which would use "sin taxes" to raise revenue as well as encourage a shift in consumer behavior, Lamont's office said.

— The proposed tax on e-cigarettes would be equivalent to 75 percent of the wholesale price, matching a current tax on tobacco. Lamont also proposed raising the age to use tobacco and e-cigarettes to 21. "The goal is to reduce lifelong smoking rates and mitigate future health issues," a Lamont spokesperson told PULSE.

— Meanwhile, there would be a 25-cent deposit for wine and liquor bottles, and a 1.5 cent-per-ounce tax on sugar-sweetened drinks. Groups like the American Heart Association have favored such moves to fight diet-related diseases and raise revenue for health programs.

Drugmakers can currently can pay generic companies to delay putting lower cost drugs on the market. Wood's bill would require manufacturers to prove they’re not being anti-competitive.

… At a press conference, Wood said such agreements allow generic companies to “make money for doing nothing. And what do patients get? Nothing — but artificially increased prices for drugs."

… California Attorney General Xavier Becerra, who joined Wood at the presser, said the bill would give the state Department of Justice more tools to determine whether companies are violating antitrust laws.

— PhRMA’s response: We're still reviewing the proposal. But a spokesperson said the Federal Trade Commission "already has the ability to review and evaluate individual patent settlements and aggressively investigates and litigates against companies that the FTC believes have harmed consumers."

AIDS United launches 'six-figure' ad campaign against Medicare Part D changes. The advocacy group has argued for months that the proposed rule — which would lift protections on six classes of drugs, including HIV medication — will limit access to those medications.

"These rule changes would allow insurance companies to interfere in my health care," says a Medicare patient in AIDS United's first ad. HHS has said that lifting the protections will make it easier for insurance companies to negotiate for lower prices and tamp down Medicare drug spending.

NAMES IN THE NEWS

RODNEY WHITLOCK moves to McDermott+Consulting. The former aide to Sen. Chuck Grassley (R-Iowa) and well-known health policy analyst left ML Strategies last week. Two members of Whitlock's team at ML Strategies — Katie Weider and Emma Zimmerman — are joining him at McDermott+.

WHAT WE'RE READING

By Dan Goldberg

Columbia University and the New York Academy of Sciences are the latest big-name institutions to reconsider their philanthropic relationships with the Sackler family, owners of pain-pill manufacturer Purdue Pharma, the Wall Street Journal's Jared S. Hopkins reports.

Chikwe Ihekweazu, director of Nigeria’s Center for Disease Control, might be the world’s first line of defense against a global pandemic, according to a profile in Nature.

The new health venture from Amazon, Berkshire Hathaway and JPMorgan Chase wants to reinvent health insurance, with a focus on benefit design, the Wall Street Journal reports.

** A message from the Campaign for Sustainable Rx Pricing: Big Pharma’s track record makes one thing clear – price gouging and patent abuse come first, and patients come last. 60% of Americans and 90% of seniors take prescription drugs – but one in four cannot afford to take them as prescribed, thanks to out-of-control prices and lack of generic competition. It’s time for a dose of reality: csrxp.org/dose-of-reality**

About The Author : Dan Diamond

Dan Diamond is the author of "POLITICO Pulse," the must-read morning briefing on health care politics and policy. He's also the creator of PULSE CHECK, the popular podcast that features weekly conversations with politicians like Sen. Susan Collins, leaders like Kaiser Permanente’s Bernard J. Tyson and thinkers like Atul Gawande.

Along with his partner Rachana Pradhan, Diamond’s high-impact reporting resulted in the resignation of HHS Secretary Tom Price. Diamond also has done prize-winning reporting on hospitals’ community obligations and deep investigations into the Trump administration’s health care strategy, including its approach to vulnerable populations.

Before joining POLITICO, Diamond served as the Advisory Board Company’s senior director of news and communications. He also covered health care policy, business, and strategy for FORBES. His work has appeared at Vox, Kaiser Health News and other publications.

Diamond is a graduate of the University of Pennsylvania and has appeared to discuss health care, politics, and policy on NPR's "All Things Considered" and "Fresh Air," the NBC Nightly News, the BBC, CBS, CNN, MSNBC, the Dan Patrick Show, and other programs. Diamond has been a Yale University Poynter fellow and a fellow of the Association of Health Care Journalists.